ABSTRACT

Exclusive breastfeeding refers to feeding an infant only with breast milk obtained directly from the mother, from a wet nurse, or expressed breast milk during the first six months of life. This study examined the psychological effects of a nurse-based intervention on exclusive breastfeeding knowledge and practices among working-class mothers. A quasi-experimental research design was adopted. The study population consisted of 40 pregnant women who were above 36 weeks of gestation and attended Iperu Primary Health Care Centre, forming the experimental group, and 32 pregnant women attending Ilisan Primary Health Care Centre, forming the control group. The sample size was determined using Leslie Kish's formula. Balloting was used to select Iperu and Ilisan Primary Health Care Centres, while convenience sampling was employed to select 15 participants from each facility, giving a total sample of 30 pregnant women. The participants from Iperu constituted the experimental group, while those from Ilisan formed the control group.

Data were collected using a structured questionnaire designed to assess mothers' knowledge and practices concerning exclusive breastfeeding. The face and content validity of the instrument were established through assessment by a panel of experts. Reliability was determined using the split-half method, and the Cronbach's alpha reliability coefficient was 0.8. The training module was also pre-tested and considered appropriate for the study. Data were analysed using the Statistical Package for Social Sciences (SPSS), version 21. Descriptive statistics, including mean and standard deviation, and inferential statistics using the Student's t-test were employed. The hypotheses were tested at a 0.05 level of significance.

The findings revealed that: (a) there was no difference in the pre-intervention knowledge of working-class mothers in the experimental group (mean = 0.519) and the control group (mean = 0.518); (b) there was no difference in their pre-intervention breastfeeding practices, with the experimental group recording a mean of 0.512 and the control group recording 0.511; (c) a statistically significant difference existed in pregnant women's knowledge of exclusive breastfeeding between the experimental and control groups after the intervention (p = 0.000); and (d) a statistically significant difference was also observed in their exclusive breastfeeding practices between the two groups (p = 0.009).

The study concluded that nurse-based interventions could improve mothers' knowledge and practices regarding exclusive breastfeeding, as participants in the experimental group demonstrated improvements following the intervention. It was therefore recommended that nursing mothers should receive regular breastfeeding-readiness education to strengthen their knowledge and encourage appropriate exclusive breastfeeding practices.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Providing nursing-based interventions, particularly breastfeeding-readiness education during antenatal visits, is essential for encouraging mothers to practise exclusive breastfeeding. Janson (2010) explained that nurse-based interventions play an important role in establishing successful breastfeeding practices. Similarly, Valine and Apaldia (2014) observed that nursing interventions involving breastfeeding education can promote early breastfeeding initiation and encourage mothers to continue breastfeeding during the first two months after delivery.

Although breast milk provides nutritional, economic, immunological, and psychological benefits, breastfeeding practices remain below the recommended standards in many communities. One factor that may influence successful breastfeeding is the availability of appropriate nursing interventions. The World Health Organization (WHO, 2010) recommends that mothers should exclusively breastfeed their babies during the first six months of life and continue breastfeeding alongside other foods until the child reaches two years of age. However, previous studies have indicated that exclusive breastfeeding remains below the recommended level (Nasserpour, Nouhjak, & Sharifat, 2010).

The WHO recommends achieving 90% universal coverage of exclusive breastfeeding to help prevent approximately 13–15% of the nine million annual deaths among children under five years in low- and middle-income countries (Jones, 2013). A report by Agunbiade and Agun (2012) in Ile-Ife also revealed that only 19% of breastfeeding mothers practised exclusive breastfeeding. Nevertheless, continuous interventions, particularly prenatal breastfeeding education, can help improve mothers' breastfeeding practices.

UNICEF (2011) described breast milk as the standard, healthiest, simplest, and most affordable source of infant nutrition because it provides the essential nutrients required by children. Nurses' knowledge, professional skills, and guidance are important in creating awareness, educating mothers, and providing the necessary support to promote successful exclusive breastfeeding. Nursing intervention strategies can therefore address some of the difficulties associated with breastfeeding by helping mothers understand the benefits of exclusive breastfeeding, including its financial and psychological advantages.

Globally, the exclusive breastfeeding rate among infants below six months of age was 38% between 2000 and 2007 (UNICEF, 2008). During the same period, the prevalence was 23% in West and Central Africa and 26% in the Middle East and North Africa. Eastern and Southern Africa recorded a rate of 39%, while East Asia and the Pacific and South Asia recorded 43% and 44%, respectively (UNICEF, 2008).

Similarly, research conducted in England revealed that exclusive breastfeeding rates were relatively low. Only 25% of infants continued to receive breast milk exclusively until six to eight weeks after birth, while 16% of mothers continued breastfeeding for between three and five months following delivery (Cernadas, Noceda, Barrera, Martinez, & Garsd, 2008).

In Nigeria, exclusive breastfeeding has also remained relatively uncommon. The Nigerian Demographic and Health Survey (2008) reported that only 13% of infants below six months were exclusively breastfed. UNICEF (2012) further reported that between 2000 and 2012, only 15.1% of Nigerian infants below six months received exclusive breastfeeding. The Nigeria Demographic and Health Survey (2013) subsequently recorded a slight increase, reporting an exclusive breastfeeding prevalence of 17%. A study conducted in Plateau State also found that only 6% of mothers practised exclusive breastfeeding (Amosu, 2010).

Niguse, Frehiwot, Dinu, and Eyerus (2016) reported that mothers' knowledge and practices regarding exclusive breastfeeding remained inadequate despite their participation in breastfeeding education programmes. Similarly, Agunbiade and Ogunleye (2012) observed that mothers continued to demonstrate limited knowledge and poor exclusive breastfeeding practices even after being exposed to relevant training programmes. Tyndall, Kamai, and Changchangi (2016) also noted that inadequate knowledge and poor breastfeeding practices persisted among mothers despite their participation in exclusive breastfeeding education.

Although several programmes have been introduced to encourage exclusive breastfeeding, challenges associated with poor breastfeeding practices continue to exist. This suggests that there may be underlying problems with the nature and effectiveness of the educational interventions provided to mothers. These concerns informed the researcher's decision to examine the psychological effects of a nurse-based intervention on exclusive breastfeeding knowledge and practices among working-class mothers attending two primary health care centres in Ikenne Local Government Area.

1.2 Statement of the Problem

Infant morbidity and mortality associated with inadequate exclusive breastfeeding practices among mothers remain major public health concerns (Onah, Osuorah, Ebenebe, Ezechukwu, Ekwochi, & Ndukwu, 2014). Poor knowledge and inappropriate breastfeeding practices have also been associated with increased cases of communicable diseases and infections among infants (Talayero, Lizan-Garcia, Puime, Muncharaz, Soto, Sanchez-Palomares, Serrano, & Rivera, 2006). Furthermore, the prevalence of diarrhoea and lower respiratory tract infections has remained high in situations where mothers have insufficient knowledge and practise of exclusive breastfeeding (Rivera, 2006).

According to UNICEF (2013), knowledge and practice of exclusive breastfeeding in Nigeria remain considerably low. Previous studies have similarly reported inadequate knowledge and poor breastfeeding practices among mothers (Chola, 2011; Rea, 2009). Inadequate exclusive breastfeeding has been associated with several health problems in children, including infections, diarrhoea, upper respiratory tract infections, childhood obesity, reduced immunity, sudden infant death syndrome, and malnutrition.

The researcher, through clinical experience, observed frequent cases of childhood malnutrition, obesity, infections, and diarrhoea. These health problems may be associated with inadequate knowledge and poor practices regarding exclusive breastfeeding. They may also indicate weaknesses in the educational programmes provided to mothers during antenatal care. This raises concerns about whether the existing breastfeeding education programmes adequately prepare mothers to initiate and maintain exclusive breastfeeding.

Although breastfeeding education programmes are available, the continued occurrence of poor exclusive breastfeeding practices suggests the need for more effective nursing interventions. Therefore, this study seeks to examine the psychological effects of a nurse-based intervention on exclusive breastfeeding knowledge and practices among working-class mothers attending two primary health care centres in Ikenne Local Government Area of Ogun State.

1.3 Objectives of the Study

The main objective of this study is to evaluate the effects of a nurse-based intervention on exclusive breastfeeding knowledge and practices among working-class mothers attending antenatal clinics in Ikenne Local Government Area of Ogun State, Nigeria.

The specific objectives are to:

1. Assess the level of knowledge of pregnant mothers regarding exclusive breastfeeding before the intervention.

2. Determine the baseline exclusive breastfeeding practices among working-class mothers.

3. Examine the influence of a nurse-based intervention on working-class mothers' exclusive breastfeeding practices after the intervention.

4. Assess the influence of a nurse-based intervention on working-class mothers' knowledge of exclusive breastfeeding after the intervention.

1.4 Research Questions

The following research questions were formulated to guide the study:

1. What is the level of knowledge of pregnant women regarding exclusive breastfeeding before the intervention?

2. What are the baseline exclusive breastfeeding practices among working-class mothers attending antenatal clinics in Ikenne Local Government Area of Ogun State?

3. What is the influence of a nurse-based intervention on exclusive breastfeeding practices among working-class mothers after the intervention?

4. What is the influence of a nurse-based intervention on working-class mothers' knowledge of exclusive breastfeeding after the intervention?

1.5 Hypotheses

The following research hypotheses were tested in the study:

HO1: There is a significant difference in pregnant mothers' knowledge of exclusive breastfeeding before and after the intervention between the experimental and control groups.

HO2: There is a significant difference in pregnant mothers' exclusive breastfeeding practices before and after the intervention between the experimental and control groups.

1.6 Scope of the Study

This study focuses on examining the psychological effects of a nurse-based intervention on knowledge and practices concerning exclusive breastfeeding among working-class mothers.

1.7 Significance of the Study

1. The findings of this study may provide useful information on the psychological effects of nurse-based interventions on mothers' exclusive breastfeeding knowledge and practices.

2. The information obtained may assist in developing appropriate strategies and interventions aimed at improving the health of mothers and their children.

3. The study may benefit nurses by demonstrating how breastfeeding education programmes can help them apply existing knowledge when making clinical decisions during antenatal clinic visits.

4. The findings may also encourage nurses to devote adequate time to providing quality nursing care and appropriate breastfeeding education to pregnant women and nursing mothers.

5. The study may serve as a useful source of information and provide a foundation for future research on exclusive breastfeeding and nursing-based interventions.

1.8 Operational Definitions of Terms

Psychological Effect: This refers to the outcome of a nurse-based educational programme on exclusive breastfeeding, as assessed through mothers' knowledge and practice scores.

Nursing-Based Intervention: This refers to the education and counselling provided to pregnant mothers on the meaning and benefits of exclusive breastfeeding to the mother, child, and community. It also involves encouraging support from husbands and other family members, as well as involving mothers who have previously practised exclusive breastfeeding to motivate and support new mothers to breastfeed exclusively during the first six months and continue breastfeeding for up to two years.

Breastfeeding: This refers to the feeding of infants and young children with milk produced by a woman's breast.

Exclusive Breastfeeding: This means feeding an infant only with breast milk, without introducing water, other liquids, or solid foods, during the first six months of life.

Pregnant Women: This refers to multiparous women who are at least 36 weeks pregnant and reside in or attend health facilities within Ikenne Local Government Area.

Practice: This refers to breastfeeding-related behaviours, including initiating breastfeeding within 30 minutes to one hour after delivery, breastfeeding frequency, feeding the baby on demand, and expressing breast milk for the baby when the mother is unavailable.